Grover disease

tran·sient a·can·tho·lyt·ic der·ma·to·sis

a pruritic papular eruption, with histologic suprabasal acantholysis, of the chest, with scattered lesions of the back and lateral aspects of the extremities, lasting from a few weeks to several months; seen predominantly in males over 40.

tran·si·ent a·can·tho·lyt·ic der·ma·to·sis

(tran'sē-ĕnt a-kan'thŏ-lit'ik dĕr'mă-tō'sis)

A pruritic papular eruption of the chest, with scattered lesions of the back and lateral aspects of the limbs, lasting from weeks to months; seen predominantly in men older than 40 years of age. Synonym(s): Grover disease.

Grover disease

(grōv′ĕr)

[R. W. Grover, contemporary U.S. dermatologist]

A common itchy (pruritic) condition of sudden onset, characterized by a few or numerous smooth or warty papules, vesicles, eczematous plaques, or shiny translucent nodules. The pruritus may be mild or severe and is aggravated by heat. Even though the condition is self-limiting, it may last months or years.

Treatment

The patient should be treated symptomatically. Heat and sweat-inducing activities should be avoided. Retinoic acid may be helpful.

1) Although the diagnostic terms Grover disease and transient acantholytic dermatosis can be used interchangeably, here we will use the more clinical conventional and widely recognizable term Grover disease.

After the original description of Grover disease, Grover and Rosenbaum (2) discovered a clinically significant association between Grover disease and other dermatitites.

The prototypic presentation of Grover disease consists of a self-limited papulovesicular rash on the upper trunk of an older white male (Figure 1).

The seasonal association of Grover disease is more controversial.

Grover disease has been found to coexist with numerous other dermatoses in 11% of cases (5); these include asteatotic eczema, allergic contact dermatitis, atopic dermatitis, irritant contact dermatitis, and psoriasis.

Histologically, the acantholysis seen in Grover disease occurs in a variety of different patterns in small, circumscribed foci resembling Darier-White disease, pemphigus vulgaris, pemphigus foliaceous, Hailey-Hailey disease, and a spongiotic dermatitis.

Eosinophils have been identified in nearly one quarter of biopsies of Grover disease, (5) which has been found by some authors to be useful in distinguishing between predominant Darier-like pattern of Grover disease and Darier disease, in which they are usually absent.

Direct immunofluorescence has been negative or nonspecific in most cases of Grover disease.

Because Grover disease has been associated with so many inflammatory and neoplastic conditions, it is important to examine each biopsy for additional diagnoses, especially concurrent hematologic malignancies, including leukemias, which may alert clinicians of progressing disease.

This theory has arisen because of the constant association of Grover disease in most case reports and small series with sun exposure, heat, and sweating.

In a large series, bed confinement was found in 21% of patients with Grover disease.

19) A syringomatous, hyperplastic, reactive proliferation has been described in Grover disease; conversely, these changes can occur in other non-eccrine-related inflammatory skin conditions, and most cases of Grover disease do not show evidence of this phenomenon.

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